CAJ | 학술논문

目的观察分析吲哚青绿(ICG)染色视网膜内界膜(ILM)剥离手术后近红外眼底荧光(NIR-FF)特点及临床意义.方法 20例22只眼纳入观察.其中,黄斑裂孔 12只眼；黄斑前膜6只眼；视网膜中央静脉阻塞1只眼；糖尿病视网膜病变3只眼.2只眼伴随视网膜色素上皮层脱离；2只眼残留增生膜；1只眼伴随融合玻璃膜疣；2只眼伴视网膜脉络膜萎缩斑；2只眼曾经行视网膜激光光凝治疗.手术前所有患眼均行眼底照相检查；2只眼行ICG血管造影检查；联合应用共焦激光眼底血管造影仪Ⅱ(HRAⅡ)与频域光相于断层扫描(SD-OCT)仪观察13只眼NIR-FF特点及视网膜微结构变化.全部患眼眼底照相未见ICG染料,13只眼进行手术前NIR-FF评估均未见ICG荧光.所有患眼均行ICG ILM染色的玻璃体切割手术(PPV).ICG浓度为0.125 mg/ml.手术后1d、2周～1个月、1.5～2个月、2.5～5个月、6～12个月对所有眼行HRAⅡ和SD-OCT联合NIR-FF检查,观察ICG在眼内代谢情况.结果全部患眼手术后黄斑部均可观察到类圆形弱荧光区域而视盘处呈现强荧光状态.其中,5只眼持续至手术后5个月,1只眼持续至手术后1年.16只眼在手术后2周～5个月即观察到黄斑部膜样结构,其余6只眼SD-OCT像表现为ILM缺失.1只眼手术后第1天整个眼底呈弥漫NIR-FF增强.手术后第2周至1年,全部患眼呈现神经纤维走形处荧光增强后消失过程.此外,在黄斑裂孔、激光光凝斑、残留增生膜、视网膜色素上皮脱离及玻璃膜疣等处均表现为强荧光信号,而脉络膜视网膜萎缩区域为弱荧光信号.结论 ICG辅助PPV手术后NIR-FF检查显示黄斑部均可观察到类圆形弱荧光区域而视盘处呈现强荧光状态,在黄斑裂孔、激光光凝斑、残留增生膜、视网膜色素上皮脱离及玻璃膜疣等处均表现为强荧光信号,而脉络膜视网膜萎缩区域为弱荧光信号.ICG代谢周期较长,在眼内最长可积存至手术后1年. 目的觀察分析吲哚青綠(ICG)染色視網膜內界膜(ILM)剝離手術後近紅外眼底熒光(NIR-FF)特點及臨床意義.方法 20例22隻眼納入觀察.其中,黃斑裂孔 12隻眼；黃斑前膜6隻眼；視網膜中央靜脈阻塞1隻眼；糖尿病視網膜病變3隻眼.2隻眼伴隨視網膜色素上皮層脫離；2隻眼殘留增生膜；1隻眼伴隨融閤玻璃膜疣；2隻眼伴視網膜脈絡膜萎縮斑；2隻眼曾經行視網膜激光光凝治療.手術前所有患眼均行眼底照相檢查；2隻眼行ICG血管造影檢查；聯閤應用共焦激光眼底血管造影儀Ⅱ(HRAⅡ)與頻域光相于斷層掃描(SD-OCT)儀觀察13隻眼NIR-FF特點及視網膜微結構變化.全部患眼眼底照相未見ICG染料,13隻眼進行手術前NIR-FF評估均未見ICG熒光.所有患眼均行ICG ILM染色的玻璃體切割手術(PPV).ICG濃度為0.125 mg/ml.手術後1d、2週～1箇月、1.5～2箇月、2.5～5箇月、6～12箇月對所有眼行HRAⅡ和SD-OCT聯閤NIR-FF檢查,觀察ICG在眼內代謝情況.結果全部患眼手術後黃斑部均可觀察到類圓形弱熒光區域而視盤處呈現彊熒光狀態.其中,5隻眼持續至手術後5箇月,1隻眼持續至手術後1年.16隻眼在手術後2週～5箇月即觀察到黃斑部膜樣結構,其餘6隻眼SD-OCT像錶現為ILM缺失.1隻眼手術後第1天整箇眼底呈瀰漫NIR-FF增彊.手術後第2週至1年,全部患眼呈現神經纖維走形處熒光增彊後消失過程.此外,在黃斑裂孔、激光光凝斑、殘留增生膜、視網膜色素上皮脫離及玻璃膜疣等處均錶現為彊熒光信號,而脈絡膜視網膜萎縮區域為弱熒光信號.結論 ICG輔助PPV手術後NIR-FF檢查顯示黃斑部均可觀察到類圓形弱熒光區域而視盤處呈現彊熒光狀態,在黃斑裂孔、激光光凝斑、殘留增生膜、視網膜色素上皮脫離及玻璃膜疣等處均錶現為彊熒光信號,而脈絡膜視網膜萎縮區域為弱熒光信號.ICG代謝週期較長,在眼內最長可積存至手術後1年.
목적 관찰분석신타청록(ICG)염색시망막내계막(ILM)박리수술후근홍외안저형광(NIR-FF)특점급림상의의.방법 20례22지안납입관찰.기중,황반렬공 12지안；황반전막6지안；시망막중앙정맥조새1지안；당뇨병시망막병변3지안.2지안반수시망막색소상피층탈리；2지안잔류증생막；1지안반수융합파리막우；2지안반시망막맥락막위축반；2지안증경행시망막격광광응치료.수술전소유환안균행안저조상검사；2지안행ICG혈관조영검사；연합응용공초격광안저혈관조영의Ⅱ(HRAⅡ)여빈역광상우단층소묘(SD-OCT)의관찰13지안NIR-FF특점급시망막미결구변화.전부환안안저조상미견ICG염료,13지안진행수술전NIR-FF평고균미견ICG형광.소유환안균행ICG ILM염색적파리체절할수술(PPV).ICG농도위0.125 mg/ml.수술후1d、2주～1개월、1.5～2개월、2.5～5개월、6～12개월대소유안행HRAⅡ화SD-OCT연합NIR-FF검사,관찰ICG재안내대사정황.결과 전부환안수술후황반부균가관찰도류원형약형광구역이시반처정현강형광상태.기중,5지안지속지수술후5개월,1지안지속지수술후1년.16지안재수술후2주～5개월즉관찰도황반부막양결구,기여6지안SD-OCT상표현위ILM결실.1지안수술후제1천정개안저정미만NIR-FF증강.수술후제2주지1년,전부환안정현신경섬유주형처형광증강후소실과정.차외,재황반렬공、격광광응반、잔류증생막、시망막색소상피탈리급파리막우등처균표현위강형광신호,이맥락막시망막위축구역위약형광신호.결론 ICG보조PPV수술후NIR-FF검사현시황반부균가관찰도류원형약형광구역이시반처정현강형광상태,재황반렬공、격광광응반、잔류증생막、시망막색소상피탈리급파리막우등처균표현위강형광신호,이맥락막시망막위축구역위약형광신호.ICG대사주기교장,재안내최장가적존지수술후1년.
Objective To observe the characteristics of near-infrared fundus fluorescence (NIR-FF)after indocyanine green (ICG) -assisted internal limiting membrane peeling.Methods Twenty-two eyes of twenty patients (12 eyes with macular hole,6 eyes with epiretinal membrane,1 eye with central retinal vein occlusion,3 eyes with diabetic retinopathy) who underwent pars plana vitrectomy (PPV) with ICG-assisted internal limiting membrane peeling were enrolled in this study.ICG solution at a concentration of 0.125 mg/ml was injected. All the patients were examined by fundus photography. Fundus fluorescein angiography (FFA) and ICGA were performed in some patients.Spectralis optical coherence tomography (SD-OCT) were performed to observe retinal microstructural changes.One day,2 weeks - 1 month,1.5 - 2 months,2.5 - 5 months,6 - 12 months after surgery,the ICG metabolism was observed.Results No ICG staining of the fundus was visible ophthalmoscopically and there was no ICG fluorescence in preoperative NIR-FF of13 eyes.Every eye had a round reduced fluorescence area in the macula and hyperfluorescence in optic disc,while five eyes were followed for up to 5 months and 1 eye was followed for 1 year after surgery.Within the round reduced fluorescence region,the membrane like structure was observed in 16 eyes during 2 weeks to 5 months after surgery and the other 6 eyes showed ILM deficiency in SD-OCT.One eye demonstrated that resident ICG scattered across the macula once on the first postoperative day,and the optic nerve fiber showed especially intense fluorescence in the area along the vascular arcade from 2 weeks to 1 year after PPV and then disappeared.Otherwise,there was enhanced ICG fluorescence in macular hole,photocoagulation scars,resident proliferative membrane and retinal pigment epithelium detachment (RPED) and drusen area,while hypofluorescence was observed in retinal and choroidal atrophy. Conclusions There are weak fluorescence areas in the macula and choroidal atrophy,while hyperfluorescence in optic disc,macular hole,photocoagulation scars, resident proliferative membrane, RPED and drusen area after ICG-assisted vitrectomy.ICG metabolic duration is longer,lasting up to 1 year after surgery.